National Provider Identifier [NPI]: |
1609020494 |
Last Name Of The Provider |
WHITE |
First Name Of The Provider |
JOSHUA |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
955 S BAILEY AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
SOUTH HAVEN |
Zip Code Of The Provider |
490909701 |
State Code Of The Provider |
MI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
24 |
Number Of Services |
399 |
Number Of Medicare Beneficiaries |
249 |
Total Submitted Charge Amount |
146758 |
Total Medicare Allowed Amount |
34989.31 |
Total Medicare Payment Amount |
25855.08 |
Total Medicare Standardized Payment Amount |
30367.25 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
24 |
Number Of Medical Services |
399 |
Number Of Medicare Beneficiaries With Medical Services |
249 |
Total Medical Submitted Charge Amount |
146758 |
Total Medical Medicare Allowed Amount |
34989.31 |
Total Medical Medicare Payment Amount |
25855.08 |
Total Medical Medicare Standardized Payment Amount |
30367.25 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
59 |
Number Of Beneficiaries Age 65 to 74 |
64 |
Number Of Beneficiaries Age 75 to 84 |
60 |
Number Of Beneficiaries Age Greater 84 |
66 |
Number Of Female Beneficiaries |
137 |
Number Of Male Beneficiaries |
112 |
Number Of Non Hispanic White Beneficiaries |
183 |
Number Of Black or African American Beneficiaries |
11 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
40 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
152 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
97 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
28 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
31 |
Percent Of With Chronic Kidney Disease |
33 |
Percent Of With Chronic Obstructive Pulmonary Disease |
24 |
Percent Of With Depression |
40 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
49 |
Percent Of With Schizophrenia Other PsychoticDisorders |
14 |
Percent Of With Stroke |
12 |
Average HCC Risk Score Of Beneficiaries |
1.8737 |